Mt. Logonot

I climbed Mt. Logonot last weekend! This is a dormant volcano about an hours drive from Kijabe. We have a great view from Kijabe of the Rift Valley below and Mt. Logonot on the otherside.

Not an easy climb, but we were able to make it up and down in about 5 hours.

Coming down was like skiing on fine dirt and pebbles!

A view from the ridge: can you find the giraffes?

Below: We found a pack of zebras near the bottom and went after them...

Transitional lucidness

A phrase I made up to describe the period of sudden alertness before death. Its a miracle in some ways, and in others unfair. Wonderful for the family to have a moment of real connection with their loved one. However you are tricked into believing, even if only for a moment, that the person is actually getting better. Unfair.

My first AIDS patient died yesterday. He has been in a coma for days now and we were at a loss as to what to do. We had already thrown every big gun antibiotic we had at him, emperically treating any of the common, serious opportunistic infections that are seen here. He was not getting better. Then, the day before yesterday, he woke up. His wife was there attempting to feed him. He was obviously communicating and we thought, Wow- this guy might just make it. We must have done something right.

Then the next morning I was the first to see him and noted that he had again lapsed and was not communicating or responding to painful stimuli. His jaw was clamped shut and he was shivering. When the team made it around to see him, he was having agonal breathing (a tell tale sign that the end is near). We completed rounds, and I went to check on him. He had already died.

Again, an HIV patient: I admitted an 10 year old boy with HIV and a cough last Friday morning at 3:00 AM. It was my first night on call (o what a night). I just found out from a friend that he died this morning. I didn't realize on admission how sick he was.

Living in Kenya is living in the context of HIV. There is almost no family that is not in some way touched by the disease. If you don't have it, someone you love probably does. Can you imagine? In Kenya- it kills. It kills your life before you even die. If you have HIV, your community no longer wants anything to do with you. Churches have been known for kicking people out once they were even suspected of having HIV, let alone confirmed positive. So what do you do? You hide until you're so sick you finally come to the hospital...and die.

What a devasting disease.

I love the story of the good Samaritan. I believe it is truly the heart of God to reach out to the hurt and dying, those cast off by their communities and even their churches. I know I have been like the righteous man who saw the dying man on the road and walked on by. But I believe that God has forgiven me through His Son, and by His grace I am able to reach out to the hurt, the dying, the HIV positive, the poor. What a beautiful gift. Even to share that moment of transitional lucidness, to love a person as they die. My prayer, though, is that I will be able to see them live more and more...

Ever feel like you're being watched?

You know, like people are staring at you, watching your every move, curious what you will do next...Its an erie feeling, almost like they are waiting for you to mess up, ready for that one moment to discount you as unworthy or inadequate.

I am a foreign visitor to this hospital. It is a tight knit community, everyone works closely with each other and they have been together for a long time. Many of the workers have spent their whole lives in Kijabe, possibly working at the hospital for generations in their family. Who am I to waltz into this place like I belong?

But I recognize that this is a wrong interpretation of that feeling of being watched. It is true, everyone is watching me, most especially the Kenyan interns and nurses. My first reaction to this constant passive attention is that I need to preform. I need to be smart medically, act quickly and intelligently, be prepared, etc. But this is not what they are looking for. I believe, instead, what they are interested in is how I am willing to interact on a more personal level. I am truly interested in the people? Or am I merely here to be some smart doctor-wanna-be from America? So my gut reaction to challenge those stares and prove my competency is almost the complete opposite of how I should be responding. I am a visitor and a learner, my response should be first humility and compassion- toward colleague or patient.

STAT! Patience

I'm sure everyone MD encounters obstetrical emergencies at some point in their training. We all know how things can go bad fast and how devastating the outcomes can be, for both mom and baby. My first experience with this was in December at Brackenridge Hospital in Austin. I had to excuse myself from the OR during a stat c-section because I could not keep from crying. I figured it was OK to let it out, at least the first time.

I have been on Ob/Gyn at Kijabe for a total of 2 days now and have already asssisted in 2 obstetrical emergencies and one other very sad case. I am not sure how much to share on a blog like this, it can be very graphic and even disturbing if you're not ready for it. Suffice it to say, I was quite overwhelmed walking home today. I unloaded it all on this poor IT tech from Ohio who was nice enough to listen .

Complicating the already serious nature of these cases is that we are operating in a very different culture than the US. Take the case from this morning: a young lady with a very large baby (which unfortunately had already died in utero), presented late last night and was delivered by a rather traumatic forcep delivery. This morning she looked very sick (and almost denied her symptoms outright), with a high heart rate, borderline blood pressure, distended abdomen, and a hemaglobin drop from 13 to 6.8. She needed the OR quickly for probable uterine rupture. But I could not believe the slow pace at which the staff set out to get her there! STAT ultrasound means maybe an hour later. STAT blood means maybe 30 min, no wait... add another 10 to that... we're in the OR but we're still waiting on blood... it'll be here in another 10 min...

And then the patient absolutely refused surgery until her family came. It didn't matter that she was dying right in front of us.

Its a very different type of place. Resources are limited, and the culture is very different. But I can say that we had the patient in the OR, her uterus sowed up (the laceration was nearly from the fundus straight into the top 1/3 of the vagina, if you can imagine that...), with the blood, and everything completed by 11 AM. That's not too bad really. She's currently recovering in the ICU and doing pretty well.

So what am I learning? Calm and patience, even when dealing with an emergency in a foreign land. And pray... don't forget to pray...

The Poor Man's Safari

Today I went on Safari!

Just a short drive from Kijabe down to the Rift Valley is a nice place we called Crecent Island on lake Naivasha. This piece of land used to become an island when the waters were high, but is now a penninsula running into the lake. Roaming free (or relatively so) are all kinds of wild animals, but no predators. Thus the poor man's safari is one without the BIG FIVE; lions, leopards, elephants, rhinos, and buffalo.

But we got a great view of zebras, wildebeasts, gazells, and giraffes... On foot!

We played 'catch that giraffe', were we flanked a family of 5 from different directions in an effort to get close enough to take pictures. How's that for a nice Saturday family outing!

Karibu Kijabe!

Karibu means 'welcome' in Swahili. Welcome to Kijabe, a beautiful village nestled in the hills above the Rift Valley. I will be staying in Kijabe for the next two months, working at the AIC Kijabe Hospital, www.kijabehospital.org

Thank you for following me during my adventure to Africa!